Thought disorder is a fiendishly difficult concept to define and the ICD does not help very much. It is difficult to separate this out from intrusive thoughts that can occur in depressive illnesses some of which are as illogical and disjointed as those observed in the various 'schizophrenias'.

One possibility for the motivational aspect is that it is a defence mechanism or a deflection from the more troubling delusions and hallucinations. The thought process is sometimes a disjointed, but nevertheless attempt at rationalising the patients situation.

The most complex one I heard was a mixture of delusion and disjointed irrational thought. This came from a man in is early 50's who had been untried for most of his life although he had been imprisoned several times and clearly was mentally disturbed. On most days he believed himself to be a Celtic god, Daghdah in fact. This had led to him deeply researching Celtic culture, largely with a view to reinforcing his claim.

He also had a deep interest in science and gave us a long lecture on the big bang theory one evening. This concluded with him pointing out to us that hydrogen was one of the first elements to appear in the universe and that we were all looking at hydrogen (him) as he spoke.

He then 'proved' to us all that he was indeed a Celtic god by adding up the numerals in his aunt Irene's birthdate which by coincidence was the atomic number of Iron. His view was that Irene was the Celtic name for iron and he must therefore be the Daghdah.

The fascinating thing about these 'thought patterns' is they were well structured and argued confidently. Some of the background material was rational but the conclusions completely tangential and impossible, classically symptomatic. All of the deliberations were in clear consciousness.

I have heard all the classic delusions, weather control, religious delusions, thought blocking (Daghdah suffered from that too) although in almost 30 years I have not met one Napoleon. I cannot recall any of this have what might be described as a social underpinning. All patients from whatever social background seem to connect with the same delusions and magnifies the same disorder of thought.

Hi Barry,

Thank you very much for your reply. You are right it is now reasonably established that "thought disorder" is an umbrella term for a range of communicational, speech and thinking "disturbances" that are indeed transdiagnostic (Cuesta & Peralta, 1999) and can be identified in a range of mental health and developmental problems (e.g. depression, autism) but also in organic pathology (e.g. epilepsy) and "healthy" populations (Andreasen, 1979).

Instances of "derailment" or "tangentiality" are often the result of the intermingling of personal concerns and worries (Harrow & Prosen, 1978) which understandably would include delusions. So in an ironic way "formal thought disorder" is actually a "disorder of thought content".

The idea that thought disorder could be a defence mechanism has been suggested a couple of times in at least two different versions I can think off (e.g. Harry Stack Sullivan). As far as I am aware, this hypothesis has never been tested...I could be wrong though! Some therapists tend to look at TD as a mechanism that the patient uses to avoid difficult topics.

Regarding your last point, I meant cognitive and biological underpinnings and social predictors. There are few ideas regarding the social origins of thought disorder such as childhood maltreatment (Toth et al., 2011), institutionalisation (Walker et al., 1981), communication deviance (Wahlberg et al., 1997). I think these offer a credible concurrent explanation to why people become "thought disordered"

What is a thought? electromagnetic charges racing along nerves with sodium-potassium pumps, chemical gates opening and closing, depolarization and repolarization, charges leaping synapses.... its a complex system so is it any wonder that it can go wrong?  A person only has to have their PH out, be dehydrated, have mineral imbalace or depleation, be exhausted or simply messed up socially and thought becomes disordered.

So often we look at the effect rather than the cause and so often its seen as very complex rather than basic homeostatic imbalance. Unfortunatly the consquences of this is overmedication when restoring the environment, externally and internally might be all that is needed. This may threaten a huge industry employing a lot of people but isnt the medical doctrine "First do no harm"....

Hi Heather, 

I agree with everything you said but I'm not so sure what you mean by "restoring the environment, externally and internally". I wouldn't necessarily disagree with the statement but I'm so sure what you meant by that.

Also, it's true that exhaustion or an electrolyte imbalance can lead to mental confusion but I'm thinking about more persistent thought disorder. More importantly I'm interested in its social predictors (e.g. family communication), it's causes. 

Homeostasis is certainly a major feature in disordered thought.  Toxins, dehydration, exhaustion and endocrine dysfunction in particular can all cause a homeostatic imbalance.  Homeostasis integrates the neural, biochemical and physical systems and has four components. signals, transducers, senosrs and responders.  signals can come from electrical impulses, neurotransmitters hormones and antigens. senosrs are receptor sites in protiens which recognaise specific signals which bind them and responders are the cellular apparatus that produces the final response.  The transducers are not fully understood but they transform one form of energy into another, such as convertng an electrical signal into the release of a neurotransmitter.

All of this has to work in an integral pattern and anyform of disturbance in this can lead to thought disorders be it temporary or permanent.  This is of course the basis of the current medication theories which are described rather crudely as correcting 'chemical imbalances'.  The anti-psychotic medications do not of course do any such thing and operate by up-regulating or down-regulating particular neurotransmitters by, for instance acting as a 5-HT receptor antagonist.  That strictly speaking cannot be described as restoring homeostasis. 

Hi Barry,

As far as I'm aware there is no specific neurobiological theory to substantiate the effect of anti-psychotics on TD. In fact, I can only recall one neurobiological theory of TD (Cohen and Servan-Schreiber). And although, it involves dopamine in the PFC, the story is not necessarily consistent with what has been tipically sold as "anti-psychotic" action of medications.    

Hi Paulo, what I meant by restoring the homeostatic environment internally as well as externally was addressing all the things which threaten or compromise mental health. Here is the list I have found to date (am happy to have others added). Remember I am not a scientist just a mental health survivor who recovered when I had a failed root canal tooth removed, had my fillings replaced with white ones and discovered that I suffer from Pyroluria. 

Known indirect risks

Childhood trauma, grief and loss, accident, abuse both physical and sexual, hormonal turmoil of adolescence, relationship distress, overwhelm, depression (over 800 medications have depression as a side effect), loss of meaning, substance abuse, addictions, gambling, dramatic change, seasonal or SADS disorder, childbirth, financial worries, over work or shift work, jet lag, loss of job/home/parents, illness, cancer, chronic pain, dental infection, natural disaster, war, post traumatic shock, hormone imbalance, menopause, loneliness, self neglect, dementia.

Even so called positive events such as dramatic life changes, infatuation, sudden large financial gain, spiritual emergence, sudden fame, near death experiences and too much sunshine can have a causal component to a change in mental health.

Known direct causes

Rabies, Toxoplasmosis (very common and caught from cat excrement), Lymes disease, Pyroluria, Porphyria, parasites, syphilis, heavy metal exposure (mercury, lead and others). Head injury, fetal alcohol syndrome, autisms, epilepsy and vaccine damage, high fever, dehydration, sleep deprivation, nutritional and mineral deficiency. Side/direct effects from illegal stimulants, mental health and other medical drugs (an example is Tamiflu induced suicide in Japanese adolescents). Incorrect use of nicotine patches, post-operative psychosis, post natal distress, physical illness, toxic poisoning, dental sepsis, direct food allergies, gastrointestinal infections, extreme physical/emotion disstress. Blood sugar imbalance, over or under thyroid, faulty methylation and B vitamin deficiency, essential fats deficiencies, histamine excess, serotonin deficiency, adrenal imbalance, acetylcholine imbalance, bladder infection, metallothionein deficiency, extreme hyperthermia... plus many more.

If mental health issues present after stress then stress has to play a large part right? Take a look at Dr Siman Yu's book Accidental Cure to see the effect of dental issues and paracites. Also Patrick Holford Optimum Nutrition for the mind. 

Hi Heather,

Are these causes of psychosis or TD?

Also, I would be interested in understanding why childhood trauma and loss, for example, are indirect causes of psychosis and toxoplasmosis and incorrect use of nicotine patches are direct causes. I'm not really sure if I understand this distinction and I'm assuming that you are considering "causes" for a wide range of mental health problems not just TD. 

Paulo, do you see mental health packaged in neat presentations or as a contininum? (sorry spell check has disapeared). I believe the 'causes' compound and thought disorder is an early sign which can become pyschosis if nothing interupts the causes of distress. Not everyone with toxoplasmosis becomes psychotic but there is a very good chance the 'mad cat lady' living with 30 cats has the parasite in large quantities. 

My Pyroluria was made evident when I had hidden dental sepsis, mercury exposure and emotional stress. Now I have addressed the last three and take enough zinc and B6 on a daily basis so as to not go into deficiency the Pyroluria is not evident. I know that I could not take suppliments, could eat badly, could not sleep enough, could have risky relationships and would soon have a mental health issue worthy of intervention and medication. But isnt this true of everyone to some extent? I am sure you would get TD if kept awake for a week and be psychotic by the second week.  

Same with childhood trauma, not everyone who experiences that goes on to have mental health issues later in life. But many who did then have issues with drink, do drugs or have volitile relationships. Add smoking withdrawls and nicotine patches to the mix and some people do 'spin out' on the patches. Nothing is in isolation, blood sugar imbalance and poor diet feed each other and then there are consquences. Over 800 medications have depression as a listed symptom, why then are they not included in discussions about the causes of depression? My point is that adressing cause seems to be a poor cousin to seeing the disorder in another person and treating their symptoms.... 

Hi Heather, 

Thank you very much for your reply.

Yes, of course I see mental health problems as a continuum but I don't agree that TD is an early sign of psychosis or even a function of psychosis.

The same way that not all psychotic patients are thought disorder - some are and some are not. And yes if I was kept awake for long I would very quickly become TD and psychotic there is no doubts about it.     

Regarding you last point, again I don't think TD is a "symptom" I guess what I've been trying to say is that I'm interested in TD as a structural phenomena not a "symptom" of a "disorder". I see it a little bit like a characteristic that may well be associated with creativity (e.g. think about James Joyce). 

Pyroluria is an extremely controversial diagnosis.

Good discussion here;

http://www.sciencebasedmedicine.org/pyroluria-and-orthomolecular-psychiatry/

.

Paul.

Have just today attended a presentation done by Paris Williams who wrote a book about mental health care and some of the more political and contentious issues around the long term use of medication. I personally believe that the voice of the educated survivor is growing and the religion of mental health as a disease that requires drugs is being challenged. Trouble is a 13 billion dollar a year business (USA from 2008) has huge weight which has been influencing, curbing and squashing any other model, even since well before Hoffer did his work. The article quoted above is full of bias against his work and its no wonder controversy is created and passed on. Where are the studies which make a genuine effort to give optimal doses of zinc, B6 and full nutrition to those who do test positive for pyroluria? 

We also watched a movie called Beyond the Medical Model and the best point made I feel was that every person enters an episode of mental/emotional distress for different reasons and therefor everyone needs a different pathway out of it again. I will read Paris's book and quote the studies which show very poor outcomes of long term medication compared to better outcomes from short term use as well as the studies showing life expectancy dropping 25 years from long term medicine use. Just last week my own recovery story was incorporated into a PHD study to explore the outcome of controlled drug reduction and stopping altogether over a period of 3 to 6 months. 

Paulo, Paris Williams is a psychologist with lived experience, I believe you would find many answers to your original question within his research and writings. 

Formal "thought" disorder (FTD) is the form of SPEECH DISORDERS (aphasio, dysphasio, shizaphasio...) Frequently the lesions are  in auditory cortex (auditory system) and in Fasciculus arcuatus. You can see many MRI and DTI studies by schizophrenic patients.

Hi Nikola, 

Thank you very much for your reply. I understand from your post that your perspective on FTD is very much in line with the early works of Chaika or even Kleist.

Although, I agree that some aspects of FTD seem to be purely linguistic and language-based. It is also true that a lot of the difficulties associated with FTD are not mediated by language - there is an extensive literature on this and probably the best exponent for this argument is Martin Harrow. There is also plenty of work showing that FTD is not a form of dysphasia or aphasia - much of it is covered in the book by Oh and McKenna: "Schizophrenic Speech" (2005).  

The MRI and DTI studies that I know of are riddled with methodological problems e.g. they don't control for symptom co-morbidity (e.g. hallucinations) or the assessment of FTD is normally flawed (e.g. assuming that FTD is a one dimensional construct) amongst other limitations. In most cases, the n is small and replication is rare (several other areas have been implicated in FTD). 

There is one meta-analysis published by Goghari (if I'm not mistaken) that shows a strong association between DLPFC and symptom-dimension - cognitive disorganisation - which reflects a rather ample set of experiences and not just FTD.  

Finally, FTD is a very dynamic and context-dependent phenomenon in most human beings labelled with "Schizophrenia". There is a colossal amount of studies showing that most FTD is state-dependent (e.g. worsens with difficult topics) and most of the biologically-informed studies have completely ignored this aspect (which is probably one of the most well replicated findings in the field).

In most cases, when the individual is not distressed by a intrusive thought or experience you can only witness very mild difficulties at the level of deixis which would be hard to spot by the everyday listener. 

In a nutshell, I don't think that one single factor is likely to explain an ample construct such as FTD. There other aspects related to the social brain that definitely play a role as communication and thought are social activities. Also, there is the all important aspect of personal meaning which is hard to explain with a single factor theory (e.g. the unfounded belief that FTD is genetic).    

Anyway, I do appreciate the post as it keeps the conversation going.

Best,

Paulo